| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
76 |
63 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
63 |
55 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
80 |
74 |
$920.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
20 |
19 |
$93.60 |
| 99173 |
|
31 |
31 |
$58.05 |
| 96127 |
|
14 |
14 |
$29.12 |
| 94760 |
|
30 |
26 |
$1.10 |